PEDIATRICS Vol. 98 No. 6 December 1996, pp. 1096-1103
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The Role of the Physical and Traffic Environment in Child Pedestrian Injuries

Phyllis F. Agran MD, MPH1, Diane G. Winn RN, MPH2, Craig L. Anderson DHSc, MPH2, Cecile Tran BS2, and Celeste P. Del Valle BA2

1 Pediatric Injury Prevention Research Group and Department of Pediatrics, University of California, Irvine, California.
2 Department of Pediatric Injury Prevention Research Group, University of California, Irvine, California.

Objective. To identify environmental risk factors on residential streets for pediatric pedestrian injuries.

Method. The sample consisted of 39 Latino children 0 to 14 years of age injured as pedestrians on a street in the same block as their home and 62 randomly selected neighborhood control subjects matched to the case by city, age or year of birth, ethnicity, and gender. The cases were identified from a population-based hospital and coroner's office surveillance system established in north-central Orange County, CA. Neighborhood assessments were performed from 3:45 PM to 5 PM, a fairly active time for young pedestrians. The cases were compared with the controls using conditional logistic regressions; in this study design, the odds ratios were interpreted as estimates of the incidence rate ratios.

Results. Children living in a multifamily residence had an incidence of injury greater than that of children living in single-family residence on a single lot (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.6). The ORs in the highest category were several times those in the lowest category for both parked vehicles (OR 9.6, 95% CI 2.6-36) and total number of pedestrians observed (OR 4.7, 95% CI 1.4-16). Vehicle parking, total pedestrians, vehicular traffic volume, and speed were examined in a multivariate model. The association of vehicles parked on the street with pedestrian injury risk remained significant. Unlike the crude results, progressively greater vehicular speed was associated with a marked increase in risk. Progressively higher vehicular traffic volume was associated with a progressively lower adjusted OR.

Conclusion. The results of this analysis would indicate that residential streets with a high proportion of multifamily residences, over 50% of the curb occupied with parked vehicles, and a large number of pedestrians observed in unenclosed areas should receive high priority for intervention programs to reduce pediatric pedestrian injuries. The analysis suggests that on these streets, measures to reduce the amount of street parking (thus increasing visibility) and reductions in vehicular speed should be considered to decrease pedestrian injuries.

Key Words: pedestrian injury • childhood • environment • risk factors • case-control study

Submitted on October 23, 1995
Accepted on February 6, 1996




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